Mumbai – Top private city hospitals under CAG fire for billing poor patients

Mumbai: In an audit of 11 leading private charitable hospitals in the city, the Comptroller and Auditor General (CAG) of India has found that seven were wrongly billing poor patients and charging hefty deposits during admission. Most hospitals reserved less than the stipulated number of beds for the poor, thereby depriving many of quality healthcare. The charity commissioner too has been pulled up for bad implementation of the scheme.

The state government has been asked to initiate action against Bombay, P D Hinduja, Lilavati, Saifee, Kokilaben Ambani, Breach Candy, Sushrut and Thane’s Bethany hospitals for failing to extend requisite facilities in lieu of the FSI and land concessions granted to them. On directions of the Bombay high court, the charity commissioner of Maharashtra in 2006 had framed a scheme for treatment of poor patients in reputed charitable hospitals.

Under the scheme, hospitals are supposed to set aside 10% of their beds for indigent patients and give concessions to another 10% from weaker sections. However, hospitals including Bombay, Lilavati, Saifee and Hinduja were also granted additional floor space index (FSI) by the BMC on the promise that they would allocate 20% of total operational beds to below-poverty-line patients free of cost. The audit found that most availed of the FSI sop but did not allocate the extra 10% beds for poor. Most also did not make a 10% reservation for outpatient services as per the scheme.

The CAG report further pointed out that Kokilaben and Sushrut hospitals, which were given land at a concessional lease of Rs 1 per annum, did not increase their reservation limit for poor patients. Kokilaben Ambani Hospital provided only 10% of beds for free and concessional treatment instead of 15%. Executive director of the hospital Dr Ram Narain said, “We continue to treat 10% patients for free and 10% on concessional rates. We can comment once there is an official communication”. Sushrut hospital, which was supposed to reserve 30% of its beds, only gave 10%.

The CAG report has asked the state to review the concessions granted to each one of them and take suitable action. Records of 11 out of 113 trust-run hospitals for the years 2012-15 were handpicked by the CAG for scrutiny.

The report particularly highlighted how poor patients were shockingly put under financial duress. Scrutiny of six bills in Hinduja and 55 bills in Bethany showed that poor patients were charged 50% towards anesthesia, ICU, doctors’ fee, imaging tests, OT and surgery charges, whereas under the scheme, they can only be billed for medicines, consumables and implants. “This led to an undue financial burden on the weaker section patients to the extent of Rs 38.03 lakh in these two hospitals,” the report stated. It also said that nine patients were made to cough up deposits amounting to Rs 1.74 lakh in blatant violation of the scheme rules.

A spokesperson for Hinduja Hospital told TOI that they have responded to all queries raised by the CAG. “We have earmarked 20% of beds for poor and weaker category patients as required under the Act. In fact, the hospital provides free or concessional treatment even to those who do not fall under the category of poor, needy and deserving as a part of our founders’ philosophy,” the spokesperson said. Bombay Hospital officials said, “The rules and regulations laid down by the Maharashtra Public Trust Act with regard to reservation of 20% beds for indigent and weaker section have been complied with. The same is practically implemented and a report is submitted regularly to authorities every month.”

The CAG report has also found loopholes in the way the IndigentPatients‘ Fund (IPF) is managed in hospitals. Charitable hospitals are required to create a separate fund called IPF, where 2% of the gross billing charged to regular paying patients, are supposed to be deposited here. The CAG report found that Breach Candy Hospital short credited the account by Rs 3.47crore from 2012-14 and Bethany too deposited Rs 1.43crore less in 2012-15.

CEO of Breach Candy N Santhanam said that the hospital complies with all norms of IPF. “We have filed a writ petition with the Bombay High Court regarding the IPF fund. The matter is sub judice so we cannot comment now,” he said.

A senior state official said that they are still studying the report and will consult with the charity commissioner before taking action against the hospitals.